Despite progress, asthma medicine cost still out of reach for most.
In Sudan, asthma is a disease of high prevalence, morbidity and economic costs, which affects 12.5% of children and 10% of adults.
In 2000, Sudan developed National Asthma Guidelines. Being one of the pioneer countries piloting asthma Standard Case Management (SCM) using The Union’s model (Chapter 11), Sudan initiated a pilot in district hospitals in Khartoum and Gezira states, commencing in 2007. With funds from the World Bank and technical assistance from The Union and World Health Organization, the pilot evolved into a full project achieving a 97% reduction in asthmarelated emergency room and reductions in asthma hospitalisations and asthma severity.
Asthma Drug Facility
When the World Bank funds expired, Sudan benefited from The Union’s Asthma Drug Facility, which demonstrated that the price of essential asthma medicines could be markedly reduced (Chapter 10). Following reductions in asthma severity, emergency room visits and hospitalisations, the project gained the Gezira State Ministry of Health’s political commitment, benefited from the Revolving Drug Fund (ensuring an uninterrupted supply of essential asthma medicines) and expanded to cover 50% of the eligible hospitals in a plan to cover the whole Gezira state.
Standard Case Management
Despite some challenges, including shortages of inhaled medicines, high turnover of trained staff and high lost-to-follow-up rates, application of SCM led to improved asthma management in Sudan.
Cost of medicines
However, despite this progress emergency rooms remain the basis of asthma management in Sudan. Long-term asthma medicines are not in the National Essential Drug List and costs are exorbitant. For example, the cost of a combination inhaler exceeds the lowest government salary per month by 25% and inhaled corticosteroids alone are almost unavailable nowadays.
The Ministry of Health should recognise asthma as an important public health issue, including asthma explicitly in healthcare planning, and scale up the current project to a nationwide programme to improve asthma care and limit costs.